Faculty, Staff and Student Publications

Language

English

Publication Date

12-1-2025

Journal

JCO Precision Oncology

DOI

10.1200/PO-25-00494

PMID

41370732

PMCID

PMC12716129

PubMedCentral® Posted Date

12-20-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Purpose: Mixed phenotype acute leukemia (MPAL) is a rare clinical entity with historically poor outcomes.

Methods: We conducted a retrospective analysis of adults 18 years and older with newly diagnosed B-cell (B/M) or T-cell/myeloid (T/M) MPAL treated at our institution between 2017 and 2024.

Results: We identified 42 patients (median age 70 years); 20 (48%) had B/M MPAL, and 22 (52%) had T/M MPAL; 57% of patients had adverse risk cytogenetics, and 41% had a TP53 mutation. Sixty-two percent of patients were treated with a hybrid regimen, and 45% of patients received intensive therapy. A composite complete remission (CRc; CR + CRi) was achieved in 57% of patients (86% measurable residual disease [MRD]-negative). After a median follow-up of 27.9 months, the median relapse-free survival in patients achieving an overall response (CRc + morphological leukemia-free state) was 10.1 months, 17.8 months in those who achieved a CRc, and not reached (NR) in patients with MRD-negative CRc. The median overall survival (OS) for all patients was 9.5 months and NR for patients achieving a CRc. Although patients with T/M MPAL had a trend toward improved survival compared with those with B/M MPAL (median OS of 9.1 v 25 months P = .28), this difference abrogated when comparison was stratified by treatment intensity. Twelve patients (29%) underwent allogeneic hematopoietic stem-cell transplantation (HSCT); on landmark analysis, HSCT trended to improve OS (NR v 22.8, P = .12). Multivariate Cox analysis demonstrated that TP53 mutation was associated with increased hazards for death (hazard ratio [HR], 3.5, P = .01), whereas the use of intensive chemotherapy trended to be favorable (HR, 0.45, P = .11).

Conclusion: Overall, these data demonstrate the need for treatment intensification in MPAL with HSCT in first remission for best outcomes.

Keywords

Humans, Male, Female, Aged, Middle Aged, Retrospective Studies, Adult, Leukemia, Biphenotypic, Acute, Aged, 80 and over, Treatment Outcome, Mixed phenotypic acute leukemia, Venetoclax, Blinatumomab, Allogeneic hematopoietic stem cell transplantation, Survival outcomes

Published Open-Access

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